Mackenzie Rhoda K, Ludlam Christopher A, Ruckley C Vaughan, Allan Paul L, Burns Paul, Bradbury Andrew W
Vascular Surgery Unit, Royal Infirmary, Edinburgh, United Kingdom.
J Vasc Surg. 2002 Apr;35(4):718-22. doi: 10.1067/mva.2002.121749.
Thrombophilia is increasingly recognized as a risk factor for deep venous thrombosis (DVT), which in turn is a major risk factor for chronic venous ulceration (CVU). However, the relationship between thrombophilia and CVU remains unknown. The aim of this study was to define the prevalence of thrombophilia in patients with CVU and to determine whether this is associated with a history or duplex scan evidence of DVT.
Eighty-eight patients with CVU were prospectively studied. The patients underwent clinical assessment and duplex ultrasound scanning. Blood was drawn for antithrombin, proteins C and S, activated protein C resistance, factor V Leiden, prothrombin 20210A, lupus anticoagulant, and anticardiolipin antibodies.
The study included 35 men with a median age of 61 years (interquartile range, 45 to 72 years) and 53 women with a median age of 76 years (interquartile range, 69 to 82 years). Thirty-six percent of the patients had either a history or duplex scan evidence suggestive of previous DVT. The following abnormalities were detected: four, five, and six cases of antithrombin, protein C, and protein S deficiencies, respectively; 14 cases of activated protein C resistance; 11 cases of factor V Leiden mutation; three cases of prothrombin 20210A mutation; eight cases of lupus anticoagulant; and 12 cases of anticardiolipin antibodies. Thrombophilia was not significantly related to previous DVT, deep reflux, or disease severity.
Patients with CVU have a 41% prevalence rate of thrombophilia. This rate is two to 30 times higher than the rate of the general population but is similar to that reported for patients with previous DVT. However, in patients with CVU, thrombophilia does not appear to be related to a history of DVT, a pattern of reflux, or severity of disease. Many patients with CVU may have unsuspected postthrombotic disease.
血栓形成倾向越来越被认为是深静脉血栓形成（DVT）的一个危险因素，而深静脉血栓形成又是慢性静脉溃疡（CVU）的一个主要危险因素。然而，血栓形成倾向与慢性静脉溃疡之间的关系仍不清楚。本研究的目的是确定慢性静脉溃疡患者中血栓形成倾向的患病率，并确定这是否与深静脉血栓形成的病史或双功超声扫描证据相关。
对88例慢性静脉溃疡患者进行前瞻性研究。患者接受临床评估和双功超声扫描。采集血液检测抗凝血酶、蛋白C和蛋白S、活化蛋白C抵抗、凝血因子V Leiden、凝血酶原20210A、狼疮抗凝物和抗心磷脂抗体。
该研究纳入了35名男性，中位年龄为61岁（四分位间距，45至72岁）和53名女性，中位年龄为76岁（四分位间距，69至82岁）。36%的患者有深静脉血栓形成的病史或双功超声扫描证据提示既往有深静脉血栓形成。检测到以下异常情况：抗凝血酶、蛋白C和蛋白S缺乏分别为4例、5例和6例；活化蛋白C抵抗14例；凝血因子V Leiden突变11例；凝血酶原20210A突变3例；狼疮抗凝物8例；抗心磷脂抗体12例。血栓形成倾向与既往深静脉血栓形成、深静脉反流或疾病严重程度无显著相关性。
慢性静脉溃疡患者中血栓形成倾向的患病率为41%。这一患病率比一般人群高2至30倍，但与既往有深静脉血栓形成的患者报告的患病率相似。然而，在慢性静脉溃疡患者中，血栓形成倾向似乎与深静脉血栓形成病史、反流模式或疾病严重程度无关。许多慢性静脉溃疡患者可能有未被怀疑的血栓形成后疾病。
